| Objective Acute graft-versus-host disease(a Gv HD)is an early major complication and cause of death after allogeneic hematopoietic stem cell transplantation.Studies have found that donors,recipients,and transplant characteristics all affect the occurrence of a Gv HD.Recently,more and more studies have found that the composition of graft cells has an impact on the outcome of transplantation,especially Gv HD.The effect of cell composition of umbilical cord blood transplantation on the outcome of a Gv HD transplantation after umbilical cord blood transplantation is rarely reported.This study analyzed the effect of umbilical cord blood transplantation cell number of total nucleated cells(TNCs),CD34+ cells,CD3+ cells,natural killer(NK)cells,CD19+ cells,and regulatory B cells(Breg)on the outcome of a Gv HD and other transplants after cord blood transplantation(CBT).Methods The study is divided into clinical and experimental parts.Clinical studies: We selected117 patients with hematologic malignancies who received CBT from the Department of Hematology of Anhui Provincial Hospital from January to December 2017.All patients were treated with a myeloablative conditioning regimen using cyclosporin A(Cs A).)with mycophenolate mofetil(MMF)to prevent a Gv HD.Clinical outcomes such as implantation,a Gv HD,recurrence,and survival after transplantation were observed and the follow-up period was March 1,2018.Laboratory study: The proportion of CD34+cells,CD19+ cells,CD3+ cells,NK cells,and naive Breg cells(CD19+CD24+CD38+CD27-)in cord blood grafts after rewarming was measured by 8-color flow cytometry.Blood cell analyzers detect TNC and calculate the absolute number of each cell subtype based on the ratio and TNC.According to the median absolute number of cells above,they were divided into high cell number group(>median)and low cell number group(≤median),and the occurrence of a Gv HD was compared between the two groups with high and low cell numbers.SPSS software was used for statistical analysis.Results1.Clinical results in 2017 1~12 months,117 patients with hematological malignancies were treated with UCBT,including 62 males and 18(1~60)years of median age.The type of disease included 45 cases of acute lymphoblastic leukemia(ALL),54 cases of acute myelocytic leukemia(AML),10 cases of myelodysplastic syndrome,4 cases of chronic myelocytic leukemia and 4 cases of other malignant hematopathy.The implantation rate of granulocytes was 100%,and the implantation rate of platelets on the 60 day was 87.2%.The median time of neutrophil implantation was 16(10-32)days,and the median time of platelets implantation was 32(11-170)days.In 117 patients with neutrophils implantation,55 cases(47%)had occurred I to IV a Gv HD,and the median time was 23(10~58)d,including 23 cases(19.6%),12(10.3%),III degree 7(5.9%),and IV 13(11.1%).There were 62 cases of no a Gv HD.In all patients,the incidence of bacterial bloodstream infection was 26.5%(31 cases),and the incidence of CMV infection was 67.5%(79 cases)after transplantation.Follow up to February 28,2018,3 cases(2.5%)recurred,16 cases died(86.3%),and 180 days total survival rate was 85.4%.2.Experimental results The median of 117 patients receiving UCBT was TNC:3.12(1.14 ~ 15.30)x 107/kg,CD34 + cells: 1.68(0.34 ~ 14.01)x 105/kg,CD19 + cells: 1.95(0 ~ 9.84)x 106/kg,Breg cells: 1.06(0 to 18.36)x 105/kg,CD3 + cells: 4.26(0.86 ~105/kg),NK cells:(0.25 ~ 12.16)x 106/kg.The effect of grafts subtypes on the occurrence of a Gv HD:(1)There was no significant difference in the incidence of a Gv HD between the two groups of CD3 +,NK and CD34 + cells(P > 0.05);(2)The ratio of the number of CD19 + cells in the two groups was significantly higher in the lower group than in the lower group of the group II to IV(P=0.018)and the grade III to IV degree(P=0.012)a Gv HD,and the difference was statistically significant;(3)There was a significant difference in the incidence of a Gv HD between the two groups in the number of TNC cells(P<0.05);(4)There was a significant difference in the number of Breg cells between the two groups in the incidence of stage III to IV a Gv HD(P=0.044).2,multivariate analysis showed that HR=2.630(P=0.027)and TNC(HR=0.872,P=0.032)had an impact on the occurrence of severe a GVHD after transplantation.Single factor analysis of patients’ age,weight,sex,HLA compatibility,input CD3 +,CD19 +,Breg cell count,and donor ABO blood group compatibility were not affected,and the input CD34 + promoted implantation(P=0.037).Multivariate analysis showed that HR=4.066(P=0.015)affected survival.Conclusions Low TNC,high CD 19 + cells and Breg cells in UCB grafts have the effect of reducing severe a Gv HD after UCBT,but the composition of graft cells has no effect on overall survival. |
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